INCIDENCE AND EPIDEMIOLOGY
Incidence of malignant pleural mesothelioma (MPM) is generally higher in males than females and is attributed to historical differences in exposures with world-standardised incidence rates per 100,000 persons of 0.7 and 0.3 in the USA and 1.7 and 0.4 for Europe (for males and females, respectively). [ Incidence of malignant pleural mesothelioma ] is highest in countries with greatest previous asbestos use such as the Netherlands, UK and Australia. Due to a lag time of around 40 years between exposure and presentation, alongside relatively recent usage bans, [ the incidence of malignant pleural mesothelioma ] continues to rise in many countries. In Europe, rates of mesothelioma were rising sharply in the early 2000s, although there is longer term uncertainty on incidence given the high usage of asbestos domestically. Moreover, in the developing world, asbestos use continues to rise. Several studies have reported better survival for females compared with males.
MPM is a relatively rare tumour classified by the World Health Organization (WHO) as directly attributable to all types of asbestos exposure and is therefore both an industrial and preventable disease. Asbestos use is currently banned in 67 countries but continues to be high in Central Asia compared with Europe, with several countries, including the USA, having no ban but only usage restrictions. Mesothelioma is a disease of the elderly, being rare below the age of 50, with a sharp rise in incidence thereafter and a median age at diagnosis of 76.
DIAGNOSIS, PATHOLOGY AND MOLECULAR BIOLOGY
Patients typically present with one or more of dyspnoea, chest pain and weight loss. Symptoms may occur over many months. During physical examination, unilateral effusions are typical. It is important that a detailed occupational history is obtained for potential legal compensation.
Standard work-up (Table 1) includes:
• Chest X-ray
• Computed tomography (CT)-scan of chest and upper abdomen
• Thoracentesis, with examination of the pleural effusion (thoracoscopy with confirmatory biopsy is preferred).
• General laboratory blood tests
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